camillians

Monday, 16 May 2011

Concern for the sick in any way has always been a part of the life of the Christian community. It leads us to the ministry of Jesus himself. This paper gives an exposition of the biblical, theological, canonical and socio-cultural bases of pastoral action of the catholic chaplain with regard to the health care ministry. Human health, sickness and healing are primary subjects. It has lots of connections with the social, cultural and religious faiths of the people. Today all illness has become treatable and many have become curable. Health has become a right and due fact for everybody. In this new concept, health is not only related to physical and physiological factors. It is also linked to mental, spiritual and emotional dimension of the person. It involves the physical emotional, social and moral environment in which the person lies and works. All these factors can generate a deep existential harmony between health, quality of life and well-being of the sick person. There are times when all of us have visited the sick and suffering. At times we are reluctant to visit them. Only thing we have to remember and realize is that this work is not only obligation in response to God’s command, but an opportunity for both the sick and ourselves where we meet God in relationship with the each other.

An appropriate and efficient medicine includes accompaniment to patient at every difficult moment of his or her life. We know that Jesus himself became a sick person and took infirmities on himself and healed them (Mt 8:17). In the first Christian community spiritual care of the sick was provided by the presbyters (James 5:13). It is clear that serving to the sick comes from Jesus, early Christian community and scripture. Today the mission of Christ is continued by the church. The church of India also should continue the task of Jesus Christ. While take care of the sick In India, we must constantly look for the dignity of the man. The dignity of man should be respected starting from life to its end. The individual is more than sum of his medical data and results. All our work in the hospital should bring recovery and health. It is not enough just to provide a care for those who are marginalized, we are compelled to make sure there is room at the table of health care for all God’s children.

When a patient is admitted in the hospital he or she is not often treated according to the wish and freedom of the patient. It is often someone else who make decisions. It would take so little to remember that the sick person also has his feelings, has wishes, and openness, and most important of all right to be cared and heard. It is a challenge to focus on the patient as a human being by being with them and rendering holistic care. Every human being desires to be loved and to love. Everybody longs for someone to be with them in the difficult times of their life journey. But more often in the hospital it appears that a sick can be saved outside his or her person hood, and so least concerned about his or her psycho-social aspects. The complexity of the medical procedures and the commercialization of the hospital care at times risk the human sanctity and dignity.

We are call to be the agents of a counter-culture by offering a valid contribution to the sick. We are called to be the promoters of health and healing. We are called to propose new ways of approaching suffering and those who suffer based upon authentic humanity and gospel. If we want to give dignity and meaning to human life the priests or the pastors in the hospital have to play a greater role. Their important functions could be the sacramental administration. According to the Indian context it could provided only to less number of people. In Indian we have less number of Christian hospitals. Therefore, the functions of the priest could be counseling, listening, providing health care education, dealing with the families etc. I have mentioned some the important roles and challenges of the pastor or the chaplain in my thesis paper.

The whole thesis is divided into three chapters. In the first chapter I have made an attempt to explain about the role of the chaplain in the hospital. The term chaplain is not much familiar in Indian context so I have used the term pastor. I have bought out some historical back ground, biblical and canonical sources to show the important of ministry to the sick in the hospitals. This chapter speaks about the important and the purpose of the pastoral care in the hospital.

The second chapter deals with the different roles of the pastors in the hospital. Some of main role of the pastors are the administration of the sacraments, conducting prayer service, counseling the patients, hospital staff, the social workers and the family members of the patients. Pastor also stands for the ethical values and integral care of the patients.

The third chapter deals with the challenges of the pastor in the hospital. The challenges especially in Indian context are focused. India seems to be a continent than country. In India we find multi cultural heritage, languages, and traditions and believe. These factors create a challenge for the pastor in the hospital. The trend of secularization, commodity of medicine is great challenge. In India Christianity also considered as the foreign religion and its activities are seen as conversion. Norms and values of one single religion cannot be applied to all people and all religions. Spiritual activity in hospital people consider as conversion. Therefore to work as hospital chaplain in India is a great challenge.

In the Gospel of Mathew chapter 25th, Jesus identifies himself with the sick and the least. He says, “as you did it to the least of these who are members of my family, you did it to me” (Mt 25:40). Visiting the sick in the hospital and taking care of the them is part of Jesus’ ministry. Though the technology in the medicine field has advance a lot these days we find lot of unexpected sickness in the world. Today most of the sick people are found in the hospitals. When someone from the family gets sickness alone with sick person whole family is affected. For any sickness medicine is important for physical healing, but medicine alone will not cure the person fully. The person needs the social, spiritual, psychological care too. The pastoral care minister/chaplain plays an important role in the hospital.

My purpose of writing thesis on this subject is to increase my sense of care towards the sick. In this chapter I would like to bring about the notion of pastoral care and chaplaincy, the origin and source of pastoral care, historical back ground, different between the pastor and the chaplaincy, when the pastoral care minister required most and the church view on pastoral care. I also have tried to explain about the importance and aims of the pastoral care giver.

The word pastoral care came from the shepherding culture of Palestine.A herd, in Greek is poimen from which the word Poimenics comes. Poimenics, is the study of pastoral work. Poimen, is a flock of sheep or herd. One who tends or care for the flock is poimenas or pastor, (Eph 4:11, Jn 10:10). The word ‘pastorarl’ is its adjective form pastor refers to the life and work pertaining to tending and caring in general. Sometimes a pastor is also referred to as ‘minister’ in Latinized form. Clebsch and Jaekle have defined the ministry of pastoral care as consisting of, “helping acts done by representative Christian persons, directed towards the healing, sustaining, guiding and reconciling of troubled persons whose troubles arise in the context of ultimate meanings and concerns.”[1]

Pastoral care is broad term that refers to all that a pastor does, including organizing, shepherding the people and communicating the gospel to them. Thus they have healing task, guiding task, sustaining task, reconciling task and nurturing task.

The pastoral care ministry began form the time of Jesus himself. That continued through different people in the church. Pastoral care was a genuine and divine act so it lasted till today through the ministers of the church.

The first Christian community saw the beaviour of Jesus Christ towards the sick as Jesus’ own task. Therefore they established the first steps for the spiritual care of the sick people.[2] They took care of them as Jesus himself was doing. It is clear from the letter of James which reads as: ‘are any among you suffering? They should pray. Are any cheerful? They should songs of praise. Are any among you sick? The y should call for the elders of the church and have them pray over them, anointing them with oil in the name of the Lord.’ (James 5:13-14). This shows how the early Christian community responded to the behavior of Christ and began with a general therapy for the sick people.

For Christians the sick person is a creature of God, a neighbour and the concrete face of Jesus Christ. The sick person is an image of God made flesh and of the passion of Christ. In this way one can well understand why the letter of James lists amongst the primary tasks of the bishop and the elders those of visiting the sick and the poor. They pray for them, anoint them with oil in the name of the lord and forgiving their sins (James 5:15).

Prayer, anointing with consecrated oil, confession and the forgiveness of sins, probably also linked with an evening meal, where the constituent elements of spiritual care for the sick. They refer to an understanding of illness as a complex of relations between physical and spiritual weakness. This is why taking care of sick people was not the task of all Christians but primarily of well specified ministers.[3]

In the second and third centuries it was made evident that taking care of the sick as a great expression of the followers of Jesus Christ. Dioiges of Alexandria expressed this in the following way: ‘without fear they visited the sick, served them with joy and took care of them according to the commandments of Christ’.[4] For them the dieing were seen as fruit of a profound spiritual life and solid faith.

“In the fourth century hospital were gradually established in which all those in need were received: foreigners, the poor, widows, orphans and the sick”[5]. Hospitals were under the authority of the bishop. Monks in particularly dedicated themselves to look after the sick and the poor. A sanatorium was often entrusted to the monastery. Under the influence of the monks a strong link between taking care of the sick and ecclesiastical discipline emerged with the development of the anointing of the sick and rules for the monks on how to behave towards sick people. For Benedictine taking care of the sick was the special duty of the community. The reason was that they considered that service to the sick as the service to Christ himself.

In the ninth century the sick had the privilege to confess their sins, receive the sacraments, listen regularly to Holy Mass, they were visited and were encouraged by the community[6]. From this we can understand the idea of taking care of the sick person. Illness was seen as a disciplinary instrument for the health. Care of the sick and pastoral care of the sick thus had a religious moral character. The medical doctor was also obliged to allow the patients for the spiritual and social care.

Till sixteen century the system of pastoral care of the sick was closely linked with the confession and the minister was priest. Due to Lutheran reformation the pastoral care of the sick fundamentally received the character of being accompanying, support and comfort. Confession was not given important, but spiritual care was not totally eliminated from the patient. However, there was great interest in the pastoral care of the sick, those in prison, and the poor.

In the nineteenth century separation of medicine and religious began, it was because of the state involvement. Hospitals moved from being monuments of God as the healer, these facilities designed to enhance medical science as well.[7] Dynamic healing ministry possesd by the church began to vanish. People began to question the benefits the visit of clergy men and many protested against their visit.

There are general relationship between the patient and the whole of the medical staff. The Good Samaritan of the Bible is the best example and model for taking care of the sick (Lk10:25-37). Christ was best example for it who took away all the possible illnesses. Mt 25:31-46 Jesus says when I was sick you cared for me. Mt 25:40 Jesus says when you did it to one of the least of my brethren here; you have done it to me. Thus Jesus identifies himself with the sick he established, a special criterion and reason for taking care of the sick. Lk 4:18, Jn 16:1ff speaks how the messiah will come and restore sight to the blind and make oppressed free. Jesus himself takes infirmities on himself and heals sick Mt 8:17. Life is one of the greatest values because it descends directly from God, the origin of all life Gen 2:27; Ezek 37:8-10. Jesus describes himself as physician, “it is not the health who need the doctor, but the sick. I did not come to call the virtuous but the sinners” (Mt 9:9-13; Mk 2:17).

CIC speaks very extensively about chaplain in canons 564-572. Each canon speaks different aspects of chaplains. The role and the position of a chaplain are explained in canon 564. It states, chaplain serves some community or group of faithful and his office is of pastoral nature.

The appointment of chaplain by local ordinary is seen in can 565. Can 566 deals with the special faculties of a chaplain. The main emphasis is given to pastoral care. The appointment of chaplain to a lay religious is the subject of can 567. Local ordinary should consult with the superior of the institute about the appointment. Chaplain does not have any right to interfere in the internal matters of institute. Appointment of chaplains to the migrants, exiles, refugees, nomads and sailors who need the pastoral care but are outside the main stream of parish life is the content of can 568. Military chaplains are governed by special laws established by Holy See. They are to be given special faculties which their ministry demands can 569 speak about it.

Though the chaplain is assigned for a specific term he can be transferred for a just cause determined by chaplain’s superior or local ordinary. Religious chaplain can be removed by notifying the other but without other’s consent.[8]

The chaplain must have all the faculties required for pastoral care which is of a virtuous and proper character. E.g. can 911 says, the chaplain has the duty and the right to carry the Most Holy Eucharist with them for the purposes of the viaticum.

As for current canonical legislation contained in the new code, we have canons 566-2 and 976 on the special authorizations for hospital to benefit the sick and for every priest in regard to those in danger of death. In the places like hospital, in prisons and during sea voyages the chaplain also has the faculty, which can be exercised to absolve people from latae sententiae, censures which are not secret or declared.

Health is a great treasure. It is the richest possession mortals can ever have. When this treasure is affected do the sick need a pastor to recover? This is a point of discussion. In almost all Christian hospitals we can see a department for pastoral care. Is there any relevance for the pastoral care for the sick? Do any sick benefit anything from it? Dose pastoral care helps people to recover? These are the question need to be answered in our pastoral care to the sick. In healing religious dimension remain predominant.[9]

Pastoral care is meaningful only when we have a holistic approach to health and healing. Disease and sufferings are evil and as such have the ability to affect the whole person in terms of his or her identity or sense of self worth.[10] So sick person verbalize these crisis in terms of why? Why me? Why I am being punished? These are the normal questions and must be answered in order to restore the person’s health. These questions are not medical questions which ordinary doctor can answer. These are theological questions which need clarification and understanding. It is unreasonable to think that these questions can be answered by professional health care workers, such as physicians and nurses. But a professional pastoral care worker is essential and required to answer all these theological questions.

Chaplain is considered as the servant of the world, so he has duty to proclaim the truth of the Gospel he applies the Gospel to the very concrete circumstances of life in hospital. As a servant of the sacraments, chaplain presides over the Eucharist and celebrates repentance and the anointing of the sick.[11] As pastors, they are sent by their bishops to the hospital. They have the mission of exhorting Christian brotherhood amongst all those who work in hospitals. They should create a pastoral group or team and co-ordinate the actions. Chaplains every time of their stay at hospital should feel that they are ministers of Jesus Christ, the sacrament of the love of God for men, every time that they are mediators and a living instruments of the grace of God towards man.[12]

To mature an awareness of the fact that their ministry is radically ordered to summoning the family of God as a brotherhood this is animated by charity and to bring it to the Father through Christ in the Holy Spirit.[13] Thus they should develop an awareness within themselves and should feel that their as the ministry of Christ. They are called to carry out their ministry in name of Christ as friends and servants of life.

According to Mayeroff, to care for another Peron means to help that person to grow and actualise himself.Caring, as helping another to grow and actualise himself, is a process, a way of relating to someone that involves development[14]. And hence there are certain essential aspects of the caring: spiritual care, physical care, social care and psychological care.

Human beings, when confronted with difficulties chose either to confront the situation or to run from it.These are the actions that allow one to survive. At times one ought to adjust them another time; one should take the circumstances in hand and change them. But in the case of a sick person if a sick person is unable to adapt to his/ her condition their condition risks deterioration.[15]

One of the essential needs for the human person is the need for personal space. It helps one to perform their proper activities and to grow. Someone who undergoes a prolonged period of hospitalisation loses this sense of equilibrium. When it happens the sick person he/she gradually looses the ability to fight back to sickness and give way to sickness. To have the personal space is also means to have the capacity to act in an autonomous manner which helps one to survive, to stand up for personal integrity, to provide his or her comfort and security, to achieve personal growth.[16]

Every human being has certain sense of need of fulfilment which he has set ahead of his /her life. But the sickness halts this need and leave it unfinished dream. Sickness brings with it many changes that often force us to give up the protective shell. It shatters the restrictive mould within which we have shaped our lives in conformity with norms of our culture and the expectations of our friends and acquaintances.[17]

In ‘Dolentium Hominium’, we see that the spiritual needs of the sick are well explained. Right from the moment of conception human beings are open to God. This basic openness enables him to give meaning to his illness, gain greater self knowledge, advance in the sense of the transcendent, find the reason for living, dying, struggling and to reach God.[18]

Most of the catholic health care communities have the facilities of pastoral care department. The pastoral care departments have a fourfold role: To heal, to sustain, to guide, and to reconcile the patients. The pastoral care team tries to help at the spiritual and social level where as other health care professionals take care of the physical and psychological level.

Trained pastoral care staffs are a great asset for a health care facility, but sometime their presence is misunderstood by the other health care professionals and the administrator. They feel patient’s spiritual needs are not their concern. Many of the health care professionals look at only one dimension of the patient’s need that is the physical dimension. Where as they forget the spiritual and social needs of the patient. The pastoral care people focus on these two dimensions. It said that the first and most important emphasis should be given to the pastoral care.[19]

The investigation shows that the chaplain should make a contribution to the humanization of the care and treatment of the sick people. It also depends on his capacity to offer himself for listening, and providing comfort to people who under go grief. It depends on his skills and expertise in diagnosing the religious and spiritual needs of patients. He should be present to help people in their reflection on ethical and spiritual questions and issues like death, forgiveness, euthanasia, abortion etc. his presence is required when people search for the meaning of life at the most difficult circumstances. He is to bring out the inner resources of the people out into the light of day.[20] His presence is required to anoint the sick, to provide Eucharist, to hear confession and all other spiritual activities. Some of the important moments his presence required are:

i) For the humanization of care and treatment of patients.

ii) Providing listening and consolation to those in need.

iii) Identifying the religious and spiritual needs of patients.

iv) At time of ethical and spiritual reflection.

v) To guide people to the search for meaning.

vi) To educate people to have respect for ethnic and other differences.

The word chaplain was seen form1340. It comes from the Greek word chapelain means ‘clergyman’ (means ‘literate one’) from M.L. cappellanus "clergyman" who was the "custodian of St. Martin's cloak.The term "chaplain" used here is a pronoun, and not a nicolaitan pedestal to stand upon.It is not a rank, but pertains to a particular "job", nothing more.

Although many faith groups and institution use ‘pastoral care’ synonymously with “chaplaincy service”, some prefer to use ‘pastoral care’ to refer to any service performed by either ordained or no-ordained persons, but reserve “chaplaincy service” for activities of performed by ordained ministers, priests, or rabbis.[22]

The priest, through his presence at the side of the sick person is a sign of the presence of Christ, not only as a minister of Christ but also as a special servant of His peace and His consolation.[23]

According to the Catholic Chaplain’s Manual “a chaplain is a priest appointed by the bishop to minister in the hospital. He is member of the healing team”.[24] A chaplain is a person of God, with special theological and Psychological training and education, committed to ministering the hospital. Pastoral care of the hospital is a team work. It is most effectively exercised by the team members. The team members of the hospital are the chaplain, doctors, nurse, medical social worker, paper medical staff, auxiliaries and others.

The chaplain in the health care institution is the priest, and to him “is entrusted in a permanent way the pastoral care of that special group of faithful made up of the sick and their family relatives and health care workers. His principal task is to preach the good news and to communicate through the administration of sacraments the redemptive love of Christ to those who suffer the consequence of the finite condition of man in body and spirit, accompanying them with solidarity-inspired love.”[25]

The chaplain in the health care center is a member of the professional team. He works for the healing of the patient. Therefore he is considered as the most treasured person in the team. He focuses the healing team, the hospital and patient. His presence in the policy making meeting will protect and propagate the Christian values and ethics.[26]

He is meant for the care of the patients and the staff. There are three levels of healing: medical, psycho-therapeutic and religious. These three are distinguished but not separated. The chaplain helps the sick person to accept his sickness and believe that he is indeed a creature of worth. It is one of the vital aspects of the medical treatment.[27] He provides care by himself and through others to the patient by making others more patient centered.

Exists to provide military personnel and their families religious programs through which a person may exercise their right of freedom of religion. The military depends upon all faith groups to provide theologically trained, spiritually motivated, and qualified ministers to serve as chaplains to military components.[28]

Health care chaplaincies are persons called by God and trained to serve in an environment of sickness, pain, birth and death. "Holistic medicine" is the term used today, meaning that people are treated as total being mind, body, and spirit. Total patient care provides for a person's spiritual as well as physical and mental needs. Chaplaincy programs offering pastoral care are key services in total patient care. The figure of the hospital chaplain or of the chaplain who belong to any other kind of health care centre is becoming increasingly important. Previously the chaplain was confined to pastoral care in the sacramental sense of the sick people. Now he is able to provide a Christian meaning to health and illness and is concerned with all the questions, issues, and difficulties which are connected to Christian health and healing.[29]

Institutional chaplaincies are comforters, pastors, teachers, and counselors. Public safety chaplains are creative and understanding as they demonstrate God’s grace and love in ministering to people, serving with law enforcement, fire department, and emergency services agencies minister to the employees of the agency as well as the people served in the community. These chaplains help people by discovering spiritual resources and faith by providing worship services, religious education, pastoral care, and counseling.

Public Safety Chaplaincies are comforters, pastors, teachers, and counselors. Public safety chaplains are creative and understanding as they demonstrate God’s grace and love in ministering to people, serving with law enforcement, fire department, and emergency services agencies minister to the employees of the agency as well as the people served in the community. These chaplains serve in full-time and part-time paid positions. Many serve as volunteers to a using agency.

Corporate chaplains are comforters, pastors, teachers, and counselors. Chaplains are creative and understanding as they demonstrate God’s grace and love in ministering to people at manufacturing sites, recreational sites, business offices, corporation headquarters and in community settings. Some chaplains will serve at management levels helping form and implement moral and ethical policies. These chaplains serve in full-time and part-time paid positions. Many serve as volunteers to a using agency.

Many corporate chaplains are hired by private companies to minister to the employees and families of the company. Some corporate chaplains are hired by "chaplaincy ministry organizations" that have contracts with companies to provide chaplaincy services. In either situation the business or agency will have their own particular qualifications for hiring chaplains. All inquiries for employment should be made to that business or agency.

Disaster Relief chaplains are members of Southern Baptist Disaster Relief teams. Disaster Relief chaplains are mobilized with their state Disaster relief team by the stat disaster relief coordinator.

As persons called by God, Disaster Relief chaplains are trained to serve in an environment of disaster relief service and response. There are not many areas of mission service that require greater spiritual sensitivity and more rapid response to human need than a disaster. Disaster Relief chaplains extend the witness and care of the church into a very specialized time of ministry in the lives of people disrupted unexpectedly by a disaster.

In the beginning hospital was an ecclesiastical institution and not medical institution. Faith and love were more important than the nursing skill and medical science. All the staff in the hospital work for the patient and not for institution. But now this notion is not understood because too often the spiritual dimensions of care is not given important by the medical staff and the administrators.

WHO defines, “the hospital is an integral part of a social and medical organization complete health care, both curative and preventive, and whose outpatient service reach out to the family in its home environment; the hospital is also a centre for the training of health workers and for bio-social research.”[31]

1.12.3.Hospital as the Place of Paradox

Hospital is the place of life and death. Many are born in the hospital and many die in the hospital. For some life begins in the hospital and for other life ends in the hospital. For some hospital sees to a beautiful and place of happiness. Because their healthy babies are born, broken bones are mended feared symptoms are diagnosed, sever pain relieved, new hope comes to life. For others hospital is ugly and place of disappointment. Their babies are born dead or deformed, feared symptoms are confirmed, legs are amputated.

It is a place where some get answers they want, some others get answers that they do not want, for other no answer at all. For some there are lot of people in the hospital so they do not lack company in the hospital, yet in the midst of all these people there are some who feel loneliness, terror, guilt and anger.[32]

Church as an institution willed by Jesus Christ, who “has taken up our infirmities and shouldered our illness” (Mt 8:17; Is 54:4). This approach is proved through various teaching. First of all man is considered as a person possessing good and values. Man is not purely earthly and temporal being, but super natural and eternal being. He has received through the eternal vocation.[33]

The church, even in the face of every other authority, through the mandate received from Christ, feels duty boundto be the sing and safeguard of the transcendent character of the human person, since she knows that man is not limited to temporal horizon alone, but while living in human history, integrally conserves his eternal vocation, for which reason the mission of the church herself, founded on the redeemer’s love, contributes to extending the radius of action of justice and love within each notion and among nations; and this is to protect and promote the fundamental rights of soul.[34]

Dignitatis Humanae no.2, states that the patient has the right to exercise his/her religious practice. For this reason in the public hospitals there should be chaplains for the spiritual care of the patient.[35] “Born in the mystery of redemption in the cross of Christ, the church has to try to meet man in a special way on the path of suffering. In this meeting man becomes the way for the church, and this is one of the most important ways.”[36]

From the NT of the Bible we understand that Christ is the divine physical of mankind and Church’s ministry to the dick and suffering has its root in Christ. Therefore we can say Christ acting through His church is mankind’s physician.[37] Vatican Council II obliges the Bishops to have special concern for the sick. It says, “they devote themselves with a paternal love to the poor and the sick”.[38] The ministry and the life of priests, the council insists that “finally, and above all, priests must be solicitous for the sick and the dying, svisiting them and strengthening them in the Lord.”[39] The same ministry is applied to the religious and the laity. Hence, the care given to the sick in the hospitals and houses should be one of the major concerns of all Christians, especially of priests and religious. Working in the hospital is not peripheral ministry of the priest, “visiting and giving comfort to the sick and dying should be very close to the heart of every priest”.[40]

1.14. Conclusion

For the pastoral care of the sick we get basis from Jesus, the Bible, church teaching and form the canon law. In India it is a great task to be consideration to take care of the sick. We have several hospitals in India but there are only one or two centres where pastoral care is given. In the NT almost forty percentage of healing ministry was show by Jesus himself. We Indian Christians are present from the first century onwards. How the much have we progressed in the pastoral care field of the sick is to be reflected in the life of each Christians and especially the priests and religious. Today people still are not aware of the chaplaincy care in India. People do not know the role and duty of the priest in the hospitals. They are confused priests’ help with the social workers. I feel we need to take care of the sick spiritually which is given by Jesus and his disciples.